Health Plans:
| Type of Plan | Meaning | Referral | PCP on Record | Out of Network Benefits | Deductible | Funding Options | Other |
| HMO | Health Maintenance Organization | Yes; prior to care outside of your PCP | Yes | No; 100% patient responsibility unless in emergency care | No | No | Some services can be Capitated to designated specialists |
| QPOS | Quality Point of Service | Yesprior to care outside of your PCP | Yes | Yes | Out of Network Only | No | Similar to HMO but with Out of Network Benefits; Some services can be Capitated to designated specialists |
| Open Access | Open Access Aetna Select | No | No | No; 100% patient responsibility unless in emergency care | No | No | Similar to HMO but without the need for a referral or PCP on record |
| CPOS II | Preferred Provider Organization | Yes | No | Yes | Out of Network Only (unless in High Deductive Health Plan – HDHP) | No | Broader Access to In Network and Out of Network Providers |
| PPO | Preferred Provider Organization | No | No | Yes | Out of Network Only (unless in High Deductible Health Plan – HDHP) | No | Broader access to In Network and Out of Network Providers |
| PPO HDHP | Preferred Provider Organization – High Deductible Health Plan | No | No | Yes | Yes | Yes *See HDHP Funding Types | Broader access to In Network and Out of Network Providers |
The specifics of your plan may vary; please consult your plan documents. Any questions regarding your benefit coverage, please contact your claim specialist at dvhtclaims@dvtrusts.com.
HDHP (High Deductible Health Plan) Funding Types:
| Funding Type | Employer Funding | Member Funding | IRS Regulated | Who Manages | What are the Funds Used For | Other |
| HSA (Health Savings Account) | Employer can fund a value equal to a percentage of the Member’s In-Network Deductible (0% to 100%) | Member can fund, pre-tax, the Remainder of the In Network Deductible – Depending on Employer Funding (100% to 0%) – subject to IRS limits | Yes | Member | Can be used on any HSA eligible expenses – Note: If you use the funds for expenses not subject to the deductible, you will need to pay that portion of the deductible out of pocket | Money is yours and goes with you. It can build interest and be invested. |
| HRA (Health Reimbursement Account) | Employer can fund a percentage of the member’s In-Network Deductible (0% to 100%) | No member funding | No | Employer and HRA Vendor | Deductible only | If funds are not used, they do not typically roll-over |
Preventive Screening and Incentives:
Please reach out to the Wellness Team at wellness@dvtrusts.com if you have any questions or would like additional information.
| Screening | Incentive – for Subscriber and Covered Spouse | Incentive Frequency | 100% Preventive Coverage Under Medical | Other |
| Colonoscopy | $150.00 | Annual | Every 10 Years – 45 years and older | If you are considered “At Risk” or need to have screenings more frequently, this would then be considered diagnostic and not preventive |
| Mammogram | $50.00 | Annual | Annual – Females 40 years and older | If you are considered “At Risk” or need to have screenings more frequently, this would then be considered diagnostic and not preventive |
| Women’s Wellness | $50.00 | Annual | Annual | |
| Biometric Screening | $150.00 | Annual | Annual |
Please see additional resources and contact your DVHT Team for more information:
HMO, PPO, POS, EPO, & HDHP: What’s the Difference – Aetna | Types of Health Insurance Plans